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1.
Trials ; 22(1): 794, 2021 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-34772437

RESUMO

BACKGROUND: Different approaches have been used by dentists to base their decision. Among them, there are the aesthetical issues that may lead to more interventionist approaches. Indeed, using a more interventionist strategy (the World Dental Federation - FDI), more replacements tend to be indicated than using a minimally invasive one (based on the Caries Around Restorations and Sealants-CARS). Since the resources related to the long-term health effects of these strategies have not been explored, the economic impact of using the less-invasive strategy is still uncertain. Thus, this health economic analysis plan aims to describe methodologic approaches for conducting a trial-based economic evaluation that aims to assess whether a minimally invasive strategy is more efficient in allocating resources than the conventional strategy for managing restorations in primary teeth and extrapolating these findings to a longer time horizon. METHODS: A trial-based economic evaluation will be conducted, including three cost-effectiveness analyses (CEA) and one cost-utility analysis (CUA). These analyses will be based on the main trial (CARDEC-03/ NCT03520309 ), in which children aged 3 to 10 were included and randomized to one of the diagnostic strategies (based on FDI or CARS). An examiner will assess children's restorations using the randomized strategy, and treatment will be recommended according to the same criteria. The time horizon for this study is 2 years, and we will adopt the societal perspective. The average costs per child for 24 months will be calculated. Three different cost-effectiveness analyses (CEA) will be performed. For CEAs, the effects will be the number of operative interventions (primary CEA analysis), the time to these new interventions, the percentage of patients who did not need new interventions in the follow-up, and changes in children's oral health-related quality of life (secondary analyses). For CUA, the effect will be tooth-related quality-adjusted life years (QALYs). Intention-to-treat analyses will be conducted. Finally, we will assess the difference when using the minimally invasive strategy for each health effect (∆effect) compared to the conventional strategy (based on FDI) as the reference strategy. The same will be calculated for related costs (∆cost). The discount rate of 5% will be applied for costs and effects. We will perform deterministic and probabilistic sensitivity analyses to handle uncertainties. The net benefit will be calculated, and acceptability curves plotted using different willingness-to-pay thresholds. Using Markov models, a longer-term economic evaluation will be carried out with trial results extrapolated over a primary tooth lifetime horizon. DISCUSSION: The main trial is ongoing, and data collection is still not finished. Therefore, economic evaluation has not commenced. We hypothesize that conventional strategy will be associated with more need for replacements of restorations in primary molars. These replacements may lead to more reinterventions, leading to higher costs after 2 years. The health effects will be a crucial aspect to take into account when deciding whether the minimally invasive strategy will be more efficient in allocating resources than the conventional strategy when considering the management of restorations in primary teeth. Finally, patients/parents preferences and consequent utility values may also influence this final conclusion about the economic aspects of implementing the minimally invasive approach for managing restorations in clinical practice. Therefore, these trial-based economic evaluations may bring actual evidence of the economic impact of such interventions. TRIAL REGISTRATION: NCT03520309 . Registered May 9, 2018. Economic evaluations (the focus of this plan) are not initiated at the moment.


Assuntos
Qualidade de Vida , Dente Decíduo , Criança , Análise Custo-Benefício , Humanos , Dente Molar , Anos de Vida Ajustados por Qualidade de Vida
2.
J Oral Rehabil ; 2021 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-34676918

RESUMO

BACKGROUND: Dentin hypersensitivity (DH) is a common problem in the population that can have a significant impact on the quality of life of those who suffer from the condition. OBJECTIVES: Compare the efficacy of two treatments for DH: Ca/PO4 - /F- varnish (Clinpro White Varnish) and ionomeric sealant (IS) (Clinpro XT Varnish) with a placebo. METHODS: Participants (121) with at least one tooth with visual analogue scale (VAS) score of 4 and above were randomly and blindly allocated to the groups. Treatments were performed by a trained researcher. DH was evaluated by another blind researcher after the treatment and after 1 week, 4 weeks, 3 months and 6 months. After 4 weeks, placebo received the DH treatment with IS; thus, the participants were not assessed after 3 and 6 months. Primary outcome was DH reduction after 4 weeks. Differences in VAS scores in the other time intervals and entire values of VAS were considered secondary outcomes. Comparisons were made among the groups (α = 0.05). RESULTS: IS showed the highest VAS value difference between baseline and 4 weeks (mean ± SD: 3.7 ± 2.2), differing significantly from placebo (2.3 ± 1.7) and Ca/PO4/F- varnish (2.6 ± 2.0). Ca/PO4- /F- varnish did not differ from placebo. In all time intervals, VAS values of all groups were significantly lower than the baseline value, without differences among groups. For the long-term differences in VAS values (3 and 6 months), the IS exhibited significantly higher values than Ca/PO4- /F- varnish. CONCLUSIONS: The IS was the most efficacious product for reducing DH, whereas Ca/PO4- /F- varnish did not differ from placebo. Registered in ClinicalTrials.gov (NCT04591444).

3.
Int J Paediatr Dent ; 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34358390

RESUMO

BACKGROUND: Information regarding Early Childhood Caries (ECC) in Mexican preschool children and its impact on quality of life is scarce. AIM: To evaluate the ECC prevalence and its impact on OHRQoL in 3-5-yr-olds Mexican children according to disease severity. DESIGN: Caries was determined at two thresholds: 1) children with at least one caries lesion (ICDAS-1-6), and 2) children with at least one lesion in dentin (ICDAS-3-6). OHRQoL was assessed through the Mexican Early Childhood Oral Health Impact Scale (M-ECOHIS). Associations among caries severity, M-ECOHIS and other variables were assessed by ordinal logistic regression. RESULTS: 409 children participated (53.8% girls, 46.2% boys). Caries prevalence was 82.2% considering all lesions, and 45.0% for dentinal lesions. Significant linear trends (p<0.05) among caries levels and categories of exposure, were found for socio-economic variables, dietary habits, and tooth-brushing habits. Attending rural private schools (OR=1.39, 95%CI=1.11-1.72 p<0.01), two main meals/day (OR=2.75, 95%CI=1.26-6.03 p=0.01) and unsupervised tooth brushing (OR=3.20, 95%CI=1.96-5.24 p<0.01) increased the risk to have high caries severity levels. CONCLUSIONS: M-ECOHIS was significantly associated with caries severity. Type of school, age groups, parents' educational level, family income, and living conditions were correlated with caries, showing how distinctive risk indicators were associated with different caries stages.

4.
Artigo em Inglês | MEDLINE | ID: mdl-34309039

RESUMO

OBJECTIVES: The purpose of this retrospective cohort study was to investigate the occurrence of sequelae in the permanent teeth after avulsion of their primary antecessors and to evaluate the factors associated with this occurrence. METHODS: We screened 2922 records of patients with photographic and radiographic images who attended a reference centre for dental trauma in the primary teeth from 1998 to 2019. Among them, 240 were eligible records of children who had suffered avulsion of the primary incisors and were followed up until complete eruption of the permanent successors. Multilevel Poisson regression analyses were conducted between the explanatory variables related to children and avulsed teeth; outcome variables were occurrences of any type of sequelae in the permanent teeth, opacities, hypoplasia and malformation. Relative risks (RRs) and respective 95% confidence intervals (95% CIs) were calculated. RESULTS: Among the 240 children's records, 194 fulfilled the inclusion criteria. Finally, we found 266 primary avulsed teeth and 115 (43.2%) permanent teeth presenting with sequelae. Avulsion occurring when children were older than 4 years (RR = 0.48; 95% CI = 0.24-0.95) had lower risks for developing sequelae than children aged 0-2 years of age. Additionally, when avulsion occurred in the lower dental arch (RR = 1.45; 95% CI = 1.06-1.99) and when three or more teeth were affected (RR = 1.57; 95% CI = 1.02-2.41), the occurrence of sequelae in the permanent teeth was more probable than if avulsion occurred in the upper arch and affected only a single tooth. Age older than 3 years was a protective factor for the occurrence of hypoplasia and age older than 4 years protective for the occurrence of opacities. CONCLUSIONS: The risk of sequelae in the permanent teeth after avulsion of their antecessor is higher when the trauma occurs in young children (<2 years) and in patients with avulsions of greater magnitude, such as when it affects the lower jaw, and more teeth are involved.

5.
BMC Oral Health ; 21(1): 371, 2021 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-34301217

RESUMO

BACKGROUND: Glass ionomer cements (GIC) have been considered the top option to restore primary teeth by dentists. The most common supply forms are hand mixed and encapsulated GIC. There is a lack of information about the impact of different GIC supply forms on restoration survival. METHODS: This randomized clinical trial compared the survival rate of occlusal and occlusoproximal restorations in primary molars using two glass ionomer cements versions: hand-mixed (H/M) and encapsulated (ENC) after 24 months. Children aged 3-10 years who presented dentin caries lesions in primary molars were selected at School of Dentistry, University of São Paulo, Brazil. They were randomly assigned to groups: H /M (Fuji IX®, GC Europe) or ENC (Equia Fill®, GC Europe). The occurrence of restoration failure was evaluated by two blinded and calibrated examiners. The analyses were performed in Stata 13 (StataCorp, USA). To evaluate the primary outcome (restoration survival), we  performed a survival analysis. Additionally an intention to treat (ITT) analysis were done at 24 months of follow-up. Cox Regression with shared frailty was performed to assess association between restoration failure and independent variables (α = 5%). RESULTS: A total of 324 restorations were performed in 145 children. The survival for H/M group was 58.2% and 60.1% for ENC, with no difference (p = 0.738). Occlusoproximal restorations had lower survival rate when compared to occlusal ones (HR = 3.83; p < 0.001). CONCLUSIONS: The survival rate in primary molars is not influenced by the different supply forms of GIC. Also, occlusoproximal restorations present reduced performances when compared to occlusal cavities. TRIAL REGISTRATION: This randomized clinical trial was registered on ClinicalTrials.Gov on 10/15/2014 under protocol (NCT02274142).


Assuntos
Tratamento Dentário Restaurador sem Trauma , Cárie Dentária , Brasil , Criança , Cárie Dentária/terapia , Falha de Restauração Dentária , Restauração Dentária Permanente , Europa (Continente) , Cimentos de Ionômeros de Vidro/uso terapêutico , Humanos , Dente Molar , Taxa de Sobrevida , Dente Decíduo
6.
BMC Oral Health ; 21(1): 255, 2021 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-33980210

RESUMO

BACKGROUND: Few studies have addressed the clinical parameters' predictive power related to caries lesion associated with their progression. This study assessed the predictive validity and proposed simplified models to predict short-term caries progression using clinical parameters related to caries lesion activity status. METHODS: The occlusal surfaces of primary molars, presenting no frank cavitation, were examined according to the following clinical predictors: colour, luster, cavitation, texture, and clinical depth. After one year, children were re-evaluated using the International Caries Detection and Assessment System to assess caries lesion progression. Progression was set as the outcome to be predicted. Univariate multilevel Poisson models were fitted to test each of the independent variables (clinical features) as predictors of short-term caries progression. The multimodel inference was made based on the Akaike Information Criteria and C statistic. Afterwards, plausible interactions among some of the variables were tested in the models to evaluate the benefit of combining these variables when assessing caries lesions. RESULTS: 205 children (750 surfaces) presented no frank cavitations at the baseline. After one year, 147 children were reassessed (70%). Finally, 128 children (733 surfaces) presented complete baseline data and had included primary teeth to be reassessed. Approximately 9% of the reassessed surfaces showed caries progression. Among the univariate models created with each one of these variables, the model containing the surface integrity as a predictor had the lowest AIC (364.5). Univariate predictive models tended to present better goodness-of-fit (AICs < 388) and discrimination (C:0.959-0.966) than those combining parameters (AIC:365-393, C:0.958-0.961). When only non-cavitated surfaces were considered, roughness compounded the model that better predicted the lesions' progression (AIC = 217.7, C:0.91). CONCLUSIONS: Univariate model fitted considering the presence of cavitation show the best predictive goodness-of-fit and discrimination. For non-cavitated lesions, the simplest way to predict those lesions that tend to progress is by assessing enamel roughness. In general, the evaluation of other conjoint parameters seems unnecessary for all non-frankly cavitated lesions.


Assuntos
Suscetibilidade à Cárie Dentária , Cárie Dentária , Criança , Cárie Dentária/diagnóstico , Testes de Atividade de Cárie Dentária , Esmalte Dentário , Humanos , Dente Decíduo
7.
Int J Paediatr Dent ; 31(4): 539-546, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33730371

RESUMO

BACKGROUND: The impact of the COVID-19 pandemic on behavioural and psychosocial aspects related to oral health is unknown. AIM: This study evaluated the psychosocial and behavioural changes related to oral health in adolescents immediately before and during the pandemic period of COVID-19, enabling a longitudinal assessment of the perceived changes. DESIGN: This cohort study evaluated 290 adolescents from November 2019 to February 2020 (T1-before the pandemic in Brazil) and from June to July 2020 (T2) in southern Brazil. Sociodemographic, behavioural, and psychosocial variables were measured before and during the pandemic. Issues related to social distancing and job loss were also collected. The differences between the variables in T1 and T2, as well as the effect of social distancing, were assessed using a multilevel-adjusted logistic regression model for repeated measures. RESULTS: A total of 207 adolescents were re-evaluated at T2 (a response rate of 71.3%). During the pandemic, the frequency of toothbrushing, the use of dental services, and the self-perceived need for dental treatment significantly decreased. Sugar consumption, bruxism, and quality of sleep did not change significantly. CONCLUSION: Behavioural and psychosocial factors showed significant changes due to the COVID-19 pandemic in adolescents.


Assuntos
COVID-19 , Pandemias , Adolescente , Brasil/epidemiologia , Estudos de Coortes , Humanos , Saúde Bucal , SARS-CoV-2
8.
Int J Paediatr Dent ; 2021 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-33728707

RESUMO

BACKGROUND: A key factor for the success and longevity of the endodontic treatment is sealing of the cavity after restorative treatment. AIM: The aim of this randomised clinical trial was to evaluate the 1-year survival of endodontic treatment in primary molars restored with stainless steel crowns (SSCs) and bulk fill composite resin (BF). As a secondary outcome, the acceptance of both children and parents was evaluated. DESIGN: Ninety-one 3- to 8-year-old children with at least one primary molar requiring endodontic treatment were selected. Participants were randomized to SSC or BF and evaluated after 1, 3, 6, and 12 months. An acceptance questionnaire was completed immediately after the treatment. The primary outcome was the endodontic treatment success, evaluated in the intention-to-treat (ITT) population using the Kaplan-Meier and non-inferiority Cox regression analyses, with a non-inferiority limit of 15%. Sensitivity analysis between the success rates after 1 year was performed using Miettinen-Nurminen's method. The Mann-Whitney test was used to compare the treatment acceptance (α = 5%). RESULTS: The survival rate after 1 year was BF = 75% and SSC = 88% (HR = 1.41; 90% CI 0.57-3.43). ITT analysis showed a success rate of BF = 86.7% and SSC = 82.6% (RR = 0.95; 0.78-1.16). The non-inferiority hypothesis between the survival of endodontic treatment could not be proved in both analyses (P > .05). The overall acceptance scores did not differ between the restorative groups (P > .05). CONCLUSION: This study failed to show non-inferiority of BF compared with the SSC. The materials were well accepted by both children and their parents.

9.
Caries Res ; 55(3): 167-173, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33789289

RESUMO

The development of dental caries in first permanent molars has been extensively investigated. However, studies are inconclusive in determining the influence of contextual and individual factors on dental caries incidence in this group of teeth. The aim of this study was to evaluate the influence of contextual and individual factors on dental caries incidence in first permanent molars. This 7-year cohort study was conducted with children (1-5 years of age) who had been assessed initially in a survey performed in 2010. Dental caries was assessed at the baseline through the International Caries Detection and Assessment System (ICDAS). Contextual and individual variables were collected at baseline and included the presence of cultural community centers in the neighborhood as well as demographic, socioeconomic, psychosocial, and biological characteristics. A multilevel Poisson regression model was used to investigate the influence of individual and contextual characteristics on dental caries incidence in first permanent molars (relative risk [RR] and 95% confidence interval [CI]). Of the 639 children examined at baseline, a total of 449 were reassessed after 7 years (70.3% retention rate). Children who lived in neighborhoods with cultural community centers had a lower risk of dental caries in first permanent molars at the follow-up (RR 0.78; 95% CI 0.62-0.99). Children from families with a low income (RR 1.34; 95% CI 1.03-1.76) and poor parental perception of children's oral health (RR 1.56; 95% CI 1.18-2.06) were associated with a higher risk of dental caries in first molars. In conclusion, individual and contextual determinants showed an important role in the incidence of caries in first permanent molars.


Assuntos
Cárie Dentária , Criança , Pré-Escolar , Estudos de Coortes , Cárie Dentária/epidemiologia , Cárie Dentária/etiologia , Seguimentos , Humanos , Incidência , Dente Molar
10.
Qual Life Res ; 30(6): 1685-1691, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33475914

RESUMO

PURPOSE: As people around the world are facing the Covid-19 outbreak, their perception of oral health problems could be changed. This study aimed to evaluate the immediate effects of the Covid-19 pandemic on oral health-related quality of life (OHRQoL) of adolescents. METHODS: A cohort study with schoolchildren from southern Brazil was conducted. Data on adolescents' OHRQoL were collected from December 2019 to February 2020 (T1), before the Brazilian Covid-19 outbreak. Posteriorly, the data were collected again in June and July of 2020 (T2), under the Brazilian Covid-19 outbreak. The OHRQoL was assessed using the Brazilian short version of the CPQ11-14. Demographic and socioeconomic characteristics and the degree of social distancing were also assessed. Changes in OHRQoL between T1 and T2 were evaluated by adjusted Multilevel Poisson regression models for repeated measures. RESULTS: From 290 individuals evaluated at T1, 207 were reevaluated at T2 (response rate of 71.3%). The overall CPQ11-14 mean score was significantly lower during the pandemic, reducing from 10.8 at T1 to 7.7 at T2. This significant reduction was also observed for all CPQ domains, indicating a lower negative impact of oral conditions on adolescents' quality of life during the pandemic. Adolescents from families that had a middle or low degree of social distancing during the pandemic and whose parents were harmed in employment had higher CPQ11-14 scores. CONCLUSION: Overall and specific-domains CPQ-14 scores were significantly lower during the Brazilian Covid-19 outbreak, indicating a decrease in the perception of oral health problems by adolescents over that period.


Assuntos
COVID-19/psicologia , Saúde Bucal/estatística & dados numéricos , Distanciamento Físico , Qualidade de Vida/psicologia , Adolescente , Brasil/epidemiologia , Criança , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pais/psicologia , Percepção , SARS-CoV-2 , Inquéritos e Questionários
11.
Am J Orthod Dentofacial Orthop ; 159(2): 175-183.e3, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33390311

RESUMO

INTRODUCTION: The purposes of this research were to identify the buccolingual inclinations of the mandibular teeth and the mandibular symphysis remodeling that result from the orthodontic decompensation movement. METHODS: The sample consisted of 30 adults with Class III dentofacial deformity, who had presurgical orthodontic treatment. Three-dimensional images were generated by cone-beam computed tomography scans at 2 different times (initial and before orthognathic surgery). Three-dimensional virtual models were obtained and superimposed using automated voxel-based registration at the mandible to evaluate B-point displacement, mandibular molar and incisor decompensation movement, and symphysis inclination and thickness. The 3-dimensional displacements of landmarks at the symphysis were quantified and visualized with color-coded maps using 3D Slicer (version 4.0; www.slicer.org) software. RESULTS: The measurements showed high reproducibility. The patients presented mandibular incisor proclination, which was consistent with the movement of tooth decompensation caused by the presurgical orthodontic treatment. Statistically significant correlations were found between the inclination of the mandibular incisors, symphysis inclination, and B-point displacement. Regarding the thickness of the symphysis and the inclination of the incisors, no statistically significant correlation was found. CONCLUSIONS: The buccolingual orthodontic movement of the mandibular incisors with presurgical leveling is correlated with the inclination of the mandibular symphysis and repositioning of the B-point but not correlated to the thickness of the symphysis.


Assuntos
Má Oclusão Classe III de Angle , Procedimentos Cirúrgicos Ortognáticos , Adulto , Cefalometria , Tomografia Computadorizada de Feixe Cônico , Humanos , Incisivo/diagnóstico por imagem , Má Oclusão Classe III de Angle/diagnóstico por imagem , Má Oclusão Classe III de Angle/cirurgia , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Reprodutibilidade dos Testes
12.
Int J Paediatr Dent ; 31(3): 422-432, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-32965714

RESUMO

BACKGROUND: Dentists should assess pathways influencing the increment of dental caries among children to guide the prevention and treatment of the disease. AIM: Evaluate the pathways that influence the increment of carious lesions in pre-school children. DESIGN: This is a 2-year cohort study was conducted with a random sample of 639 pre-school children in southern Brazil. Caries experience, socioeconomic status (SES), social capital, and psychosocial characteristics were obtained at baseline. Increment of dental caries was assessed at 2 years follow-up in 467 children (cohort retention rate of 73.1%). Previously calibrated examiners assess the caries through the International Caries Detection and Assessment System (ICDAS). Structural equation modeling (SEM) was performed to test the pathways influencing dental caries increment. RESULTS: Dental caries at baseline was heavily influenced by children's age (SC: 0.381, P < .01), tooth plaque (SC: 0.077, P = .02), parent's perception child oral health (SC: 0.295, P < .01), and household (SC: 0.148, P < .01). Increment of dental caries was directly affected by dental caries at baseline (Standardized Coefficients [SC]: 0.377, P < .01). Indirect paths were not significant. CONCLUSIONS: Dental caries experience was the main factor of direct influence on the increment of caries, reinforcing the theory of risk accumulation over time.


Assuntos
Cárie Dentária , Brasil/epidemiologia , Criança , Estudos de Coortes , Cárie Dentária/epidemiologia , Humanos , Classe Social , Fatores Socioeconômicos
13.
Caries Res ; 55(1): 12-20, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33326970

RESUMO

To investigate the efficacy of atraumatic restorative treatment (ART) sealants vs. no sealant in preventing the development of dentine caries lesions in first permanent molars over a period of 3 years. A total of 187 schoolchildren (aged 6-8 years) from a low-income population presenting the 4 first permanent molars without clinically detectable dentine caries lesions were selected to be part of a split-mouth clinical trial. All 4 first permanent molars were investigated in this trial and the children's mouth was split vertically into left and right sides; therefore, 2 molars were randomly allocated to receive ART sealants, while the other 2 molars remained nonsealed. All children received toothbrushing instructions and dietary advice every 6 months for a period of 3 years. Clinical evaluations were performed after 3, 6, 12, 18, 24, and 36 months and both sealant retention and dental caries were scored. Kaplan-Meier survival analysis, log-rank test, and Cox regression with shared frailty analysis were performed. A cavitated dentine caries lesion was considered a failure. The cumulative survival rates of dentine cavity-free first permanent molars were 90% for ART-sealed molars and 90.8% for nonsealed molars, with no statistically significantly difference between sealed and nonsealed molars (p = 0.70). The retention of sealants was not associated with the development of cavitated dentine caries and children presenting a higher baseline caries experience had greater chances of developing dentine lesions. In conclusion, the application of ART sealants was not more efficacious than nonsealing in reducing the development of dentine cavitated lesions in first permanent molars.


Assuntos
Tratamento Dentário Restaurador sem Trauma , Cárie Dentária , Criança , Cárie Dentária/prevenção & controle , Cimentos de Ionômeros de Vidro , Humanos , Dente Molar , Selantes de Fossas e Fissuras/uso terapêutico
14.
Braz. oral res. (Online) ; 35: e004, 2021. tab, graf
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1132741

RESUMO

Abstract: There is a lack of evidence about the best approach for cavitated caries lesions with the possibility of pulpal involvement in primary teeth. Thus, the present authors aimed to verify the best treatment for deep caries lesions with or without pulp involvement in primary teeth. The search was conducted in MEDLINE/Pubmed and Web of Science databases until May 2020. Studies that compared techniques to manage deep caries lesions with at least 12 months of follow-up were included. The risk of bias was evaluated using the RoB tool. Network meta-analysis and pairwise meta-analyses were conducted considering the treatment clinical success as an outcome, according to the pulp health condition. From 491 potentially eligible studies, 9 were included. For deep caries lesions with pulp vitality, the Hall Technique presented the highest probability of success (78%). In the event of accidental pulp exposure, pulpectomy presented a 76% chance of providing the best clinical results. For pulp necrosis, no difference was observed between a pulpectomy and non-instrumented endodontic treatment (RR = 0.69; 95%CI: 0.21-2.33) Thus, it was concluded that the Hall Technique may be a better option for deep caries lesions with pulp vitality. In cases of accidental pulp exposure of vital teeth during caries removal, a pulpectomy may be considered the best option. However, there are insufficient studies to build up evidence about the best treatment option when irreversible pulpitis or pulp necrosis is present.


Assuntos
Humanos , Dente Decíduo , Cárie Dentária/terapia , Pulpectomia , Polpa Dentária , Metanálise em Rede
15.
BMC Oral Health ; 20(1): 317, 2020 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-33172449

RESUMO

BACKGROUND: The assessment of restored teeth in dentistry remains a challenge, mainly related to the detection of caries around restorations. There is a diversity of clinical criteria available to assess the caries lesions, resulting in differences in the dentists' diagnosis and treatment decisions. In addition, there is a lack of evidence regarding the best criteria to detect caries lesions around the restorations. Thus, the present protocol aims to evaluate the effect of using 2 visual criteria to assess restored teeth on the outcomes related to oral health in adults. METHODS: The design protocol of the Caries Cognition and Identification in Adults trial correspond to a triple-blind randomized, controlled clinical trial with parallel-groups. Two groups will be compared: patients who will receive the diagnosis and treatment decision according to FDI (World Dental Federation) criteria-FDI group; and patients who will receive diagnosis and treatment decision according to the "Caries Associated with Restorations or Sealants" criteria defined by the International Caries Classification and Management System (ICCMS group). The participants will be followed up after 6, 12, 18, 24, and 60 months, and the restoration failure will be the primary outcome. The analysis will be conducted through Cox regression with shared frailty. The impact of oral health on quality of life and the cost-effectiveness of the methods used will be the secondary outcomes. Two-tailed analyzes will be used, considering a level of significance of 5%. DISCUSSION: This is the first clinical trial to assess the effect of using two visual methods to detect caries lesions around restorations on the outcomes related to oral health in adults. The findings of this study will define what is the best diagnostic strategy for the assessment of caries around restorations in permanent teeth. Trial registration NCT03108586 (registered 11 April 2017).


Assuntos
Cárie Dentária , Qualidade de Vida , Adulto , Cognição , Cárie Dentária/diagnóstico , Cárie Dentária/terapia , Suscetibilidade à Cárie Dentária , Restauração Dentária Permanente , Dentição Permanente , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
BMC Oral Health ; 20(1): 318, 2020 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-33176756

RESUMO

BACKGROUND: Atraumatic Restorative Treatment (ART) and the Hall Technique (HT) are both minimally invasive, non-aerosol generating procedures (non-AGPs). They seem to have never been directly compared, nor has the HT been studied in a non-clinical setting. This study compared the HT and ART restorations placed in a school setting after 36 months. METHODS: Children (5-10 yo) who had a primary molar with a dentinal occluso-proximal, cavitated carious lesion were allocated to the ART (selective removal) or HT arms. PRIMARY OUTCOME: restoration survival over 36-months (using Kaplan-Meier survival analysis, log rank test, and Cox regression). SECONDARY OUTCOMES: (1) occlusal vertical dimension (OVD) (1, 2, 3, 4 weeks) and (2) child self-reported discomfort; (3) treatment acceptability (immediately following interventions); (4) Child Oral Health Related Quality of Life (OHRQoL), before treatment and after 6 months and (5) a post hoc analysis of time to tooth exfoliation (1, 6, 12, 18, 24, 30, 36 months). RESULTS: One-hundred and thirty-one children (ART = 65; HT = 66) were included (mean age = 8.1 ± 1.2). At 36 months, 112 (85.5%) children were followed-up. PRIMARY OUTCOME: restoration survival rates ART = 32.7% (SE = 0.08; 95% CI 0.17-0.47); HT = 93.4% (0.05; 0.72-0.99), p < 0.001; Secondary outcomes: (1) OVD returned to pre-treatment state within 4 weeks; (2) treatment discomfort was higher for the HT (p = 0.018); (3) over 70% of children and parents showed a high acceptability for treatments, with crown aesthetics being a concern for around 23% of parents; (4) Child OHRQoL improved after 6 months; and (5) teeth treated with the HT exfoliated earlier than those in the ART group (p = 0.007). CONCLUSIONS: Both ART and the HT were acceptable to child participants and their parents and all parents thought both restorations protected their child's tooth. However, the crown appearance concerned almost a quarter of parents in the HT arm. Children experienced less discomfort in the ART group. Although both treatments can be performed in a non-clinical setting and have the advantage of being non-aerosol generating procedures (non-AGPs), the HT had almost three times higher survival rates (93.4%) for restoring primary molar occluso-proximal cavities compared to ART (32.7%). TRIAL REGISTRATION: This trial was registered in ClinicalTrials.gov (NCT02569047), 5th October 2015. https://clinicaltrials.gov/ct2/show/study/NCT02569047?cond=Hall+Technique+Atraumatic+Rest orative+Treatment&draw=2&rank=2.


Assuntos
Tratamento Dentário Restaurador sem Trauma , Cárie Dentária , Criança , Cárie Dentária/terapia , Restauração Dentária Permanente , Estética Dentária , Seguimentos , Humanos , Dente Molar , Qualidade de Vida , Instituições Acadêmicas , Dente Decíduo
17.
Braz Oral Res ; 35: e004, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33206777

RESUMO

There is a lack of evidence about the best approach for cavitated caries lesions with the possibility of pulpal involvement in primary teeth. Thus, the present authors aimed to verify the best treatment for deep caries lesions with or without pulp involvement in primary teeth. The search was conducted in MEDLINE/Pubmed and Web of Science databases until May 2020. Studies that compared techniques to manage deep caries lesions with at least 12 months of follow-up were included. The risk of bias was evaluated using the RoB tool. Network meta-analysis and pairwise meta-analyses were conducted considering the treatment clinical success as an outcome, according to the pulp health condition. From 491 potentially eligible studies, 9 were included. For deep caries lesions with pulp vitality, the Hall Technique presented the highest probability of success (78%). In the event of accidental pulp exposure, pulpectomy presented a 76% chance of providing the best clinical results. For pulp necrosis, no difference was observed between a pulpectomy and non-instrumented endodontic treatment (RR = 0.69; 95%CI: 0.21-2.33) Thus, it was concluded that the Hall Technique may be a better option for deep caries lesions with pulp vitality. In cases of accidental pulp exposure of vital teeth during caries removal, a pulpectomy may be considered the best option. However, there are insufficient studies to build up evidence about the best treatment option when irreversible pulpitis or pulp necrosis is present.


Assuntos
Cárie Dentária , Dente Decíduo , Cárie Dentária/terapia , Polpa Dentária , Humanos , Metanálise em Rede , Pulpectomia
18.
Braz Oral Res ; 34: e089, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32785478

RESUMO

In this study, we evaluated the physicochemical properties (PCP; radiopacity, flow, pH, and solubility) and the quality of root canal filling provided by an experimental industrialized paste (EP), with the same active ingredients as those of the Guedes Pinto paste, compared with the Vitapex® paste. PCP were analyzed according to the ANSI/ADA laboratory testing methods for endodontic filling and sealing materials. To analyze filling capacity, 120 artificial primary teeth (60 maxillary incisors [MIs] and 60 mandibulary molars [MMs]) were endodontically treated. The teeth were divided into eight groups based on the dental group (MIs or MMs), filling material (Vitapex® or EP), and insertion method (syringe or lentulo). The Image J® software was used to analyze the initial an final digital radiographies of each tooth, measuring and comparing root canal and void areas. The percentage of filling failure areas was obtained. Data were submitted to ANOVA and Tukey test of mean comparison. Regarding PCP, both pastes presented results according the ANSI/ADA standards. Flow capacity: Vitapex: 19.6 mm, EP: 25 mm (p < 0.01); radiopacity: Vitapex: 4.47 mmAl, EP: 6.06 mmAl (p < 0.01); pH after 28 days: Vitapex: 7.79, EP: 8.19 (p = 0.12); and solubility after 28 days: Vitapex: 2.68%, EP: 2.89% (p > 0.05). Regarding filling capacity analysis, EP demonstrated 12.5% of failure against 31.5% of Vitapex (p < 0.01). Compared to Vitapex, EP presented statistically significantly better results in flow, radiopacity, pH, and filling capacity. Molars presented more filling failures than incisors. The insertion method using a syringe and a thin tip was significantly better than that using Lentulo spiral carriers.


Assuntos
Radiografia Dentária Digital , Dente Decíduo , Hidróxido de Cálcio , Hidrocarbonetos Iodados , Materiais Restauradores do Canal Radicular , Obturação do Canal Radicular
19.
Braz Oral Res ; 34 Suppl 2: e073, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32785483

RESUMO

The impact of clinical trials on patient care depends on the outcomes that they evaluate. In Dentistry, many trials use outcomes that are important to clinicians, but not to the patients. Thus, the aim of the present manuscript is to present an overview of the limitations, challenges, and proposals on the use of clinically relevant outcomes (CRO) in dental trials. Clinically relevant outcomes are variables that directly measure how the patient feels, functions, or survives. Some CROs, such as tooth loss, implant failure, and restorations failure require many years to occur and the number of events is low. The adoption of these variables as primary outcomes results in challenges for the researchers, such as use of large sample sizes and long follow-up periods. Surrogate outcomes, such as biomarkers, radiographic measurements and indexes, are frequently used to replace CROs. However, they present many limitations, since the effect of the treatment on a surrogate does not necessarily reflect a change in the clinical outcome. Some proposals for the adoption of CROs are presented, such as the development of core outcome sets within each dental specialties and the organization of multi-center clinical trials.


Assuntos
Ensaios Clínicos como Assunto , Falha de Restauração Dentária , Humanos , Doenças Estomatognáticas , Resultado do Tratamento
20.
J Dent ; 101: 103446, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32758684

RESUMO

OBJECTIVE: To evaluate the 2-year survival rate and the cost-effectiveness of Atraumatic Restorative Treatment (ART) using three different glass ionomer cements (GICs) for restoring occlusal dentin caries lesions in primary molars. METHODS: One hundred and fifty (150) 4-8-year-old children were selected, randomly allocated and treated in school tables according to the restorative material: Fuji IX Gold Label (GC Corp), Vitro Molar (nova DFL) and Maxxion R (FGM), the latter two being low-cost brands. Materials and professionals' costs were considered to analyse baseline total cost, and from this the cumulative cost of each treatment was calculated. Restoration assessments were performed after 2, 6, 12 and 24 months by an independent calibrated examiner. Restoration survival was estimated using Kaplan-Meier survival analysis and Cox regression was used to test association with clinical factors. Bootstrap regression (1,000 replications) compared material´s cost over time and Monte-Carlo simulation was used to build cost-effectiveness scatter plots. RESULTS: The overall survival rate of occlusal ART restorations after 2 years was 53% (Fuji IX = 72.7%; Vitro Molar = 46.5%; Maxxion R = 39.6%). Restorations performed with Vitro Molar and Maxxion R were more likely to fail when compared to Fuji IX. At baseline, Fuji IX was the more expensive option (p < 0.001), however, considering the simulation of accumulated cost caused by failures until 2-year evaluation, no difference was found between the groups. CONCLUSIONS: After 2 years' follow up, restorations performed with Fuji IX proved to be superior in terms of survival, with a similar overall cost, when compared to low-cost glass ionomers cements (Vitro Molar and Maxxion R).


Assuntos
Tratamento Dentário Restaurador sem Trauma , Cárie Dentária , Criança , Pré-Escolar , Custos e Análise de Custo , Cárie Dentária/terapia , Restauração Dentária Permanente , Cimentos de Ionômeros de Vidro , Humanos , Dente Molar , Análise de Sobrevida
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